Helping victims of offenders who are not criminally responsible

In Canada’s criminal justice system there is strong discussion about offenders who are found not criminally responsible because they have a mental illness (NCR). Our federal government has recently proposed a bill in Parliament that could keep some NCR offenders removed from the community for a longer period of time, but there is also a focus in the Act on “enhancing victim’s involvement.”

Drs. Jason Quinn, a CAMH Psychiatric Resident, and Alexander Simpson, Chief of Forensic Psychiatry, attempt in a recent article in the Journal of the American Academy of Psychiatry and the Law to suggest how the forensic system could address the needs of victims, who have been called “the forgotten party”, but still maintain the rights of the NRC patient. Such patients are often “doubly stigmatized” as being mentally ill and “are often confined for longer than if they had pleaded guilty.”

Quinn and Simpson point out the practical difficulty that forensic psychiatrists typically understand their duty to care for their NCR patient (and ensure public safety), with the involvement of the person victimized not falling into this doctor-patient relationship. But still, victims may be suffering and concerned about the person who harmed them.

Unfortunately, the answer to this simple question, as the authors tell us, remains uncertain, in part because of the limited information they found after conducting a literature review on the subject. I found many comments in the review disheartening: for example, victims want a voice in the justice system, but at times this, understandably, can “speak more to a desire for retribution.” They also note that “There is no clear evidence that ongoing victim impact statements are helpful for the victim’s recovery…” Similarly, if the victim is involved with the patient, how can patient confidentiality be protected?

Quinn and Simpson note that “restorative justice” processes are effective elsewhere in the criminal justice system. The authors mention some studies showing that “victims who went through [restorative justice] had reduced post-traumatic stress symptoms, anger and desire for retribution” and that perpetrators reoffended less often. To be successful, this approach would “require the joint engagement of the victim and perpetrator so that they hear each other; understand feelings, concerns, and remorse; and aid in the recovery of both.”

This makes good sense, but the authors admit that this approach will be highly complex and require considerable adaptation when involving those offenders who are mentally ill.

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The Centre for Addiction and Mental Health (CAMH) is Canada's largest mental health and addiction teaching hospital, as well as one of the world's leading research centres in the area of addiction and mental health.

We combine clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental health and addiction issues.